IVF: chance of getting pregnant even after many attempts
Many doctors estimate the chances of pregnancy after three or four unsuccessful IVF cycles to be so low that they advise against further attempts. But a German meta-analysis now shows that an artificial insemination can even be worthwhile until the ninth attempt.
After unsuccessful in vitro fertilization (IVF), many women lose hope of ever becoming pregnant, and from trial to experiment, the situation is usually more distressing. To investigate the true prospects for pregnancy after many IVF trials, researchers from Berlin have now reviewed the data of more than 156,000 women who underwent artificial insemination in German centers.
For the study did not count the achieved pregnancies, but only how many children actually were born. It turned out that after the first IVF almost every third woman had a child. Many women discontinued treatment after the first unsuccessful attempt, but among those who continued, the proportion of women who had a baby increased from round to round. After six attempts, 65 percent of the women had a baby, and there were still opportunities after that, albeit small ones.
Since it is not known whether women who stop treatment after one or more IVF attempts have the same chance of success as women undergoing further cycles, the researchers immediately made several calculations. In addition to a conservative estimate (which takes the dropout's odds at zero) and an optimal guess (which assumes that the dropouts have the same chances as the repeaters), they still calculated an age-adjusted rate (which takes the woman's age into account) and a prognosis -adjusted estimate. The latter assumes that 30 percent of drop-outs would have had no chance of getting pregnant. In the prognosis-adjusted estimate, which according to the study authors is particularly realistic, the chance of a living child rose from 54 percent after three cycles to 68 percent after nine cycles.
This is how an in vitro fertilization works
Many people who are interested in fertility treatment have already heard of in vitro fertilization (IVF), but they have a limited understanding of the treatment itself. The many unanswered questions often lead to uncertainties.
IVF is one of today's common treatment methods within reproductive medicine. The term comes from the Latin and means "fertilization in the glass". In this form of assisted fertilization, ovum and sperm do not merge in the oviduct of the woman, but are brought together in the test tube.
At the beginning of each IVF treatment is a detailed interview with the patient. In the course of various preliminary examinations, the general state of health as well as the medical history of the patient are clarified. This pre-treatment phase usually takes three to four weeks and allows the doctor to clarify the causes of unwanted childlessness and to set up an individualized treatment plan.
The treatment itself begins with the stimulation. The follicle-stimulating hormone (FSH) is administered by an injection under the skin and ensures the growth of multiple follicles. The injection of the hormones can be taken after a briefing by the patient herself. The aim of the stimulation is that the follicles reach a certain size. The stimulation phase is individual for each woman. The right time for collection is determined by ultrasound and blood tests. When this time is reached, the trigger syringe triggers the final maturation of the eggs. An HCG preparation or GnRH agonist prepares the oocyte solution from the follicles and they are ready for collection.
The follicular puncture (oocyte removal) takes place about 36 hours after the injection syringe and is usually performed on an outpatient basis under light anesthesia and ultrasound control. The procedure takes only 10 to 15 minutes. The doctor punctures the ovaries with a cannula attached to the ultrasound head through the vaginal wall and sucks up follicular fluid in which the oocytes are located. In parallel, the man is asked to give a fresh sperm sample.
Now comes a decisive moment during the treatment. Eggs and sperm are brought together "in-vitro" - the next day the laboratory worker sees whether a fertilization has taken place. If successful, the embryos are monitored in the laboratory until they can be inserted into the uterus.
The embryo transfer finally takes place two to five days after the puncture. It lasts only a few minutes and is painless for most patients. As a rule, the doctor transfers one or two embryos to the uterus, which then settle into the uterine lining in the following days. To exclude an overstimulation syndrome (OHSS) and to examine the luteal phase, an ultrasound examination can be performed after about one week, if necessary.
The pregnancy test takes place about 14 days after embryo transfer with the help of a blood sample. If the result is negative, an evaluation discussion is carried out and it is discussed whether another treatment cycle is being carried out. In the case of a positive result, an ultrasound examination is carried out after one to two weeks and the further procedure is discussed between the doctor and the patient in need of a child. At the seventh week of pregnancy, when the embryo is about five millimeters in size and has a heartbeat, the patient is referred back to her gynecologist, who accompanies her for the remainder of the pregnancy.
It is often asked what is the likelihood of getting pregnant through IVF treatment or how long the treatment lasts. To give a clear answer to that is not easy. A fertility treatment can not guarantee a pregnancy even under optimal conditions. Thus, IVF treatment is often a process that requires a lot of time and patience. It is not uncommon for success to occur after the fourth to sixth oocyte withdrawals because the probability of pregnancy remains about the same in the first few treatment cycles.
The likelihood of pregnancy is even slightly higher for an IVF treatment than for a fertile couple trying to get pregnant naturally. If two embryos are transferred to the uterus, it is between 20 and 40 percent, depending on their age. However, it should be noted that there is a twin risk of about 20 percent for a transfer of two embryos.